Elzette Rousseau from the Desmond Tutu HIV Foundation told attendees at the top HIV conference in the United States about a project taking HIV prevention services to schools in Cape Town. Biénne Huisman visited one of the sites to find out how it works.
Beside a cluster of gum trees at Woodlands High in Mitchells Plain, colourful trucks parked on the school grounds bring contraceptives, services for sexually transmitted infections, and three types of PrEP (pre-exposure prophylaxis) to pupils 15 years and older - these are an HIV prevention pill, a vaginal ring, and a prevention injection.
Woodlands High is one of sixteen schools and colleges in Cape Town where rotating "FAST PrEP" mobile clinics from the Desmond Tutu HIV Foundation see nurses dispense the latest safe sex tools during second break, and after classes. FAST PrEP is the foundation's project aimed at increasing PrEP uptake particularly amongst young people.
The project has four roving clinics. Other sites in the Klipfontein-Mitchells Plain health sub-district frequented at regular intervals include Philippi Village, the Philippi library and local retail junctures.
At Philippi Village, beside a rainbow-emblazoned FAST PrEP truck; Esethu Tebe, a member of the project's youth reference group, told Spotlight that she became involved after seeing digital influencer Zuki Lamani post about FAST PrEP on Tik-Tok. Indeed, the researchers are contracting local influencers to visit the mobile clinics, depicting HIV prevention as hip and "cool" on social media platforms such as Instagram, Facebook and Tik-Tok. Another Cape Town role model, Parfait Munyemana, posted about visiting the clinic on Instagram, ending with "stay safe my loves".
During the Philippi site visit, lead FAST PrEP investigator Elzette Rousseau, a social behavioural scientist with the foundation for the past ten years, explained that adolescent girls and young women remain disproportionately at risk of HIV infection, hence their efforts to target this demographic. She added that they paid members of the project's youth reference group - eighty young people aged 15 and above - for advice on how to best resonate with youngsters.
Over 14 000 young people reached
And the data shows that their interventions are working. On the other side of the world, Rousseau last week presented her research at the annual Conference on Retroviruses and Opportunistic Infections (CROI) hosted in San Francisco in the United States. She joined fellow speakers to lead a symposium on pioneering models of HIV prevention delivery.
In Rousseau's presentation, "We'll Come to You: A Mobile Clinic Preexposure Prophylaxis Delivery Model", she relayed that their project had initiated over 14 000 adolescents and young people on PrEP since August 2022. Of these, 10 000 youngsters mostly aged between 15 and 24 years accessed the medicine at Fast PrEP mobile clinics. She said that about 8 500 of their PrEP initiates were adolescent girls and young women.
In addition, Rousseau said given a choice of prevention pills, the dapivirine vaginal ring, or a long-acting injection containing the ARV cabotegravir (Cab-LA); 74% of their PrEP initiates chose Cab-LA. Spotlight previously covered the initial pilot roll-out of the injection, which provides two months of protection against HIV infection per shot.
In her presentation, Rousseau added that 69% of initiates cited making their choice of PrEP based on how it fits with their lifestyles. "Facilitators of uptake and continued PrEP use include convenient service locations (mobile clinics), peer support, and accessible information on PrEP options via community outreach and social media," she said.
On the preference for long-acting injections, she said: "PrEP product switching from oral to longer-acting methods was mostly related to product attributes - discreetness, longer protection, and fewer perceived side effects."
Buy-in from schools
Back in Philippi, Rousseau smiled while recounting how they gained access to school premises, describing this as a major win for the project. She said they applied for permission to the Western Cape Department of Education, which granted approval with two provisos: that each school governing body be consulted and that exam times are exempt.
"If there's not enough space inside school grounds, we normally park just outside the gate," she said. "We normally go during second break and stay until after school is out. So many come for contraceptives and then they start hearing about PrEP, and then take that option as well."
She added that on rotation they visit the same site every week or two weeks, to cater for returning healthcare seekers or "clients".
At the Philippi Village site, Rousseau introduced Spotlight to FAST PrEP's marketing coordinator and social media expert, Mbali Jonas.
Reflecting on their youth strategy, Jonas said: "I engage with the youth reference group to understand their preferences and values pertaining to healthcare, and how we as FAST PrEP can bridge gaps they may face through communication efforts and demand creation. As a result, they share trendy social media ideas, suggest ways to frame positive messaging online that is relatable, relevant, youth-friendly, non-judgemental, inclusive..."
The mobile clinic consists of two trucks parked next to each other. Inside one, Phaphama Sifingo is seated in front of a desktop computer, a box of banana flavoured condoms at his side. "I am a peer navigator, so my job here is to welcome people," he said. "I'm the one registering them, as in opening their files, and I educate them about the services that we do here." Sifingo went on to demonstrate the project's biometric filing system, whereby patients are identified by their fingerprints. Thus, all medical records are instantly available online, eradicating cumbersome paperwork.
In the other truck, Sister Ntoyahto Thembeka meets with clients, administering services such as the HIV prevention injections. Thembeka started working in FAST PrEP's mobile clinics two years ago, before which she was a nurse with the City of Cape Town, based at the Claremont, Westridge and Gugulethu clinics.
At the mobile clinic, she said she sees up to thirty patients a day: "It depends on the area you are in. If there's too much community rush in that area, you can see more."
Asked about being employed by FAST PrEP in comparison to local government, she responded: "It depends on your passion. If you're passionate, you can't compare the two. You can compare the environment, the settings - things may be done differently because of the protocols and the policies. But in the end your passion for health stays the same. You're dealing with a person, with their feelings, the social behaviour, with the community that we serve - whether it's your child, your brother, your grandchild, your mother."
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
Bridge to the community
Rousseau told Spotlight that it took initial training to accustom nurses working for FAST PrEP to collaborate with young people as closely as they do - due to traditional views on hierarchy; respect for elders and those with experience and qualifications.
The project's youth reference engagement facilitator Siwe Mphambaniso, described his involvement: "I lead the youth reference group, which is the bridge between the project and the community. Just recently we had a session all about STIs. We talk about issues that affect them as youth."
Describing the project as successful, Mphambaniso said he wished it could be implemented beyond the present catchment area. "We are making a difference, but I think we need to do more," he said. "I think we need to reach other regions as well, places like Khayelitsha. I believe more people need these services so my wish would be to spread them."
During our drive from Philippi back to the Desmond Tutu HIV Foundation's headquarters in Woodstock, Rousseau said unfortunately the project would probably not be rolled out any wider due to funding constraints. "I guess it is potentially a bit more expensive than government health facilities to run so it's funding dependent," she said.
She added that despite global funding cuts hitting the sector, causing havoc and curbing essential healthcare services across countries, FAST PrEP's financial backing appears to be secure.
